Chronic Pain

Medical treatments and pain clinics

Several of the people that we talked to had attended hospital appointments for medical treatments to relieve their pain or for prescription of specific pain relieving medication. Medical interventions are not intended to cure pain but may give relief when pain is particularly bad and help people get more mobile.

Often people attended a specialist pain clinic. Pain clinics vary in the treatments offered and not all hospitals have a specific pain clinic. Some are run by a Consultant with a special interest in pain, others also have a physiotherapist, a nurse or a psychologist. Some had attended a pain clinic that was run by a specialist pain nurse.

Most people found the pain clinic staff helpful and some commented that it was good to be referred somewhere with a real interest in pain. A man who was very sceptical at first said that the nurse who put him on an exclusion diet and then gave him gabapentin and morphine, had been more help than his four consultants put together.

Another man said he was even happy when they told him that they couldn't cure him, although he was a little disappointed that the waiting lists for treatments were so long.

Some were critical of aspects of the pain clinic. A woman who found the pain clinic helpful felt it would be better if she could always see the same doctor, especially if it could be one of the 'good ones'.

A man found it frustrating that the pain clinic seemed to follow an inflexible protocol and didn't seem to listen to him. Others were not interested in the treatments offered, either because they were concerned about the side effects of steroid injections or because other patients told them that they had found treatments were painful or ineffective.

Sometimes people have their medications changed after assessment at the Pain Clinic. Often this was morphine based medication or medications prescribed specifically for nerve type pain (e.g. gabapentin and amitriptyline) (see also 'Medication: strong opioids'; Medication: antidepressants and antiepileptics').

Others had received pain relieving injections. The type of injection depended on the origin of the pain. The drugs that are injected are also dependent on the condition but include steroids to reduce inflammation and anaesthetics. Steroids are known to cause bone disintegration if they are used long term.

Some people do not have sufficiently strong bones to have injections and others do not want to risk the side effects. People didn't always remember being told all about the possible side effects before treatment.

The two most common procedures talked about involved injections into the spine for back and lower limb pain. These were often day case procedures, however people were normally recommended to arrange for somebody else to take them home.

A man who had actually gone against this advice explained that one risk of injections into the spine was a sudden drop in blood pressure. Spinal injections were normally carried out in a special treatment room or operating theatre and sometimes it was necessary to use a type of x-ray to guide the procedure. People were awake during the procedures although some opted to take a sedative and others were offered a local anaesthetic.

People whose pain originated from damage to the joints in the spine were sometimes given 'facet joint injections'. Some experienced pain relief which they said allowed them to become more active. However, others found the procedure painful and felt that the pain relief was not worth it. A few people were concerned because they had been told that injecting steroid into the spine could cause further degeneration of the bones.

A woman who had taken many years to decide to have these injections found them painful but not as bad as expected and was pleased with the pain relief. She and others were encouraged to return to normal activity and exercise a few days after the procedure. However, several stressed that it was important to stay within their limitations and not over do things.

Epidural injections were given when the pain was believed to originate from the nerves of the spinal cord. After the initial couple of days recovery from the procedure most experienced some pain relief. However the relief was only temporary and some felt that if they were done repeatedly they became less effective, which put them off having any more.

A woman who'd had a number of lumbar epidurals pointed out that they only helped relieve the nerve pain in her leg not her low back pain but she still felt that they were worth having.

A man who had an epidural, which had helped him get back on his feet, was put off having any more because of the potential side effects, including the risk of injecting into the wrong part of the spine. An older woman had been told that she wasn't suitable for a second epidural but wondered whether this was more to do with her age.

A few people were offered cortisone injections for pain in the joints of their limbs. Many people were put off having them because they only provide short-term relief and that they could only have a limited number because of bone degeneration. A couple of people that we talked to had experienced some relief, but a woman said she found the procedure unpleasant and was not sure she would go down that route again.

A few people mentioned other treatments that are sometimes offered at a pain clinic specifically for nerve pain. These included ketamine or lignocaine infusion and sympathetic blocks for nerve pain due to a brachial plexus injury. A woman with MS had been referred to an anaesthetist who had given her hope that her pain might be helped by lignocaine patches.

Some had heard about procedures, which are not widely available in the UK including spinal stimulators and morphine pumps and wanted more information.

A few people had also received acupuncture through a pain clinic and others had been able to borrow a TENS machine (see also 'Complementary approaches' and 'Physical therapies').

In some areas there are plans to set up more pain management services in the community, no one we interviewed had used these services.

Last reviewed May 2015.

Last updated November 2012.

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